Association between glycemic control in different emotional conditions and adherence to carbohydrate counting in people with type 1 diabetes during the COVID-19 pandemic in Brazil / Associação entre controle glicêmico em diferentes condições emocionais e adesão à contagem de carboidratos em pessoas com diabetes tipo 1 durante a pandemia de COVID-19 no Brasil

ABSTRACT Objective Evaluate the association between glycemic control in different emotional perceptions and the adherence to carbohydrate counting by adults with type 1 diabetes during the COVID-19 pandemic in Brazil. Methods This cross-sectional, descriptive, and analytical study was approved by the Research Ethics Committee (Opinion nº 4,147,663) and conducted in July 2020 using a Google Forms® form. Socioeconomic and demographic data were collected; glycemic monitoring according to the individuals' emotions at the time of measurement (happy, motivated, or hopeful; stressed or anxious; sad, distressed, or with depressive symptoms); data on adherence to carbohydrate counting and social distancing. Pearson's Chi-Square test was applied with adjusted residual analysis (p<0.05). Results Approximately 64.62% of the 472 participants, had hyperglycemia when stressed/anxious, and 52.97% when they felt sad/distressed/depressive (p<0.000). Associations were observed between having normoglycemia in any emotional situation and performing the carbohydrate counting (p<0.000); perceiving oneself as happy/motivated/hopeful and having hyperglycemia, and not measuring blood glucose was associated with not having the carbohydrate counting (p<0.000); being stressed or anxious was associated with not measuring blood glucose and not having the carbohydrate counting (p<0.000). Conclusion The need for multidisciplinary care to enhance mental health and adherence to treatment for people with type 1 diabetes is highlighted.

RESUMO Objetivo O estudo objetivou avaliar a associação entre o controle glicêmico em diferentes percepções emocionais e a adesão à contagem de carboidratos por adultos com diabetes tipo 1 durante a pandemia de COVID-19 no Brasil. Métodos Trata-se de um estudo transversal, descritivo e analítico aprovado pelo Comitê de Ética em Pesquisa (Parecer 4.147.663), realizado em julho de 2020 por meio de formulário Google Forms®. Foram coletados dados socioeconômicos e demográficos; monitoramento glicêmico de acordo com as emoções do indivíduo no momento da mensuração (feliz, motivado ou esperançoso; estressado ou ansioso; triste, angustiado ou com sintomas depressivos); dados sobre adesão à contagem de carboidratos e distanciamento social. Aplicou-se o teste qui-quadrado de Pearson com análise residual ajustada (p<0,05). Resultados Dos 472 participantes, 64,62% apresentavam hiperglicemia quando estressados/ansiosos, e 52,97%, quando se sentiam tristes/angustiados/depressivos (p<0,000). Foram observadas associações entre ter normoglicemia em qualquer situação emocional e realizar a contagem de carboidratos (p<0,000), perceber-se feliz/motivado/esperançoso e ter hiperglicemia, assim como não medir a glicemia foi associado a não ter a contagem de carboidratos (p<0,000). Estar estressado ou ansioso foi associado a não medir a glicemia e não ter a contagem de carboidratos (p<0,000). Conclusão Destaca-se a necessidade de atendimento multidisciplinar para potencializar a saúde mental e a adesão ao tratamento de pessoas com diabetes tipo 1.

The association between depression symptom endorsement and glycemic outcomes in adolescents with type 1 diabetes.

OBJECTIVE: The prevalence of depression among adolescents with type 1 diabetes is estimated to be 2-3 times higher than in the general population. In adults with type 1 diabetes and depression, short-term outcomes are worse compared to individuals just diagnosed with type 1 diabetes. This study aims to determine if depressive symptom endorsement is associated with glycemic outcomes and short-term complications in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: Analysis was conducted using electronic medical records from the T1D Exchange Quality Improvement Collaborative. Adolescents with type 1 diabetes, aged 12-18, receiving treatment in a diabetes clinic who had been screened for depression with the PHQ-9 between 2016 and 2018 were eligible for inclusion. Individuals must have also had HbA1c data available from the day of depression screening and from 10 to 24 weeks after screening; the final sample size was 1714. RESULTS: Almost 30% of adolescents endorsed mild or greater (PHQ-9 ≥ 5) depressive symptoms. Endorsement of mild or greater depressive symptoms was associated with an 18% increased risk of an HbA1c ≥7.5% and a 42% increased risk of an HbA1c ≥9.0% on the day of screener administration. Depressive symptom endorsement was also associated with an 82% increased risk for DKA. CONCLUSIONS: This study suggests that depression symptoms are associated with an increased risk for elevated HbA1c and short-term complications. With the rising incidence of type 1 diabetes in youth, routine screening, and appropriate management of depression is needed.

Socioeconomic deprivation, technology use, C-peptide, smoking and other predictors of glycaemic control in adults with type 1 diabetes.

AIMS: Intensive glycaemic control is associated with substantial health benefits in people with type 1 diabetes. We sought to examine clinical and demographic factors associated with meeting glycaemic targets in type 1 diabetes. METHODS: We conducted a cross-sectional analysis of 4594 individuals with type 1 diabetes. The primary outcome of the study was assessing factors associated with meeting HbA1c targets. Secondary endpoints included factors associated with continuous subcutaneous insulin infusion (CSII) use and persistent C-peptide secretion. RESULTS: Socioeconomic deprivation was strongly associated with a lower likelihood of achieving an HbA1c <58 mmol/mol (7.5%) (20% in the most deprived quintile vs. 40% in the least deprived, p < 0.001). In multivariate analysis, absence of smoking history (OR 3.06, p < 0.001), flash monitoring (OR 1.49, p < 0.001), CSII (1.43, p = 0.022) and longer diabetes duration (OR 1.02 per year, p = 0.004) were independently associated with achieving HbA1c <58 mmol/mol (7.5%), whereas increasing age (OR 0.99 per year, p = 0.004) and C-peptide <50 pM (OR 0.58, p < 0.001) were associated with a lower likelihood of meeting this target. Low C-peptide (<50 pM) was less likely in men (OR 0.55, p < 0.001) and never smokers (0.44, p < 0.001) in multivariate analysis. CONCLUSIONS: Lower levels of deprivation, non-smoking, higher C-peptide, technology use, lower BMI and male gender were all associated with a higher likelihood of meeting HbA1c targets. Access to proven diabetes treatments is lower in the most deprived individuals. Urgent efforts are required to provide treatments which are effective across the socioeconomic gradient.

Association of habits, triggers, glycaemic control, routines, stress and impulse control among emerging adults with type 1 diabetes.

AIM: Glycaemic control is known to be poor among emerging adults with type 1 diabetes, but the reasons for this are poorly understood. Examination of diabetes self-management-related habits, triggers and daily routines within the context of impulse control and perceived daily stress may provide increased understanding of glycaemic control during this transitional period. This study examined associations among checking blood glucose (CBG) habits, eating a meal (EAM) habits and glycaemic control within the context of CBG triggers, daily routines, impulse control and perceived daily stress, in emerging adults with type 1 diabetes. METHODS: A cross-sectional convenience sample of 100 emerging adults with type 1 diabetes was recruited from an outpatient diabetes care clinic for this age group. Participants self-reported frequency of CBG and EAM habits, CBG triggers, daily routines, perceived daily stress and impulse control. Glycaemic control values were obtained from medical records. Path analysis was performed. RESULTS: Better glycaemic control was positively and significantly associated with greater frequency of CBG and EAM habits. CBG habits were positively and significantly associated with CBG triggers and EAM habits. EAM habits were positively and significantly associated with daily routines. CONCLUSIONS: We suggest interventional research targeting CBG and EAM habits and daily routines to examine the impact on diabetes self-management and glycaemic control.

Automated glycemic control with the bionic pancreas in cystic fibrosis-related diabetes: A pilot study.

Cystic fibrosis-related diabetes (CFRD) is the most common extrapulmonary manifestation of cystic fibrosis. The current standard of care for CFRD involves treatment with insulin, typically via multiple daily injections. We conducted a small pilot study comparing usual care with automated glycemic control using the bihormonal (insulin and glucagon) and insulin-only configurations of the bionic pancreas. Both configurations of the bionic pancreas achieved good glycemic control, with mean glucose levels <150 mg/dl and minimal hypoglycemia. Subjects reported improved treatment satisfaction and reduced burden of diabetes management with the bionic pancreas. Further investigation of automated glycemic control in the treatment of CFRD is warranted.

Conhecimento dos pacientes diabéticos usuários do Sistema Único de Saúde acerca da retinopatia diabética / Knowledge of diabetic patients users of the Health Unic System about diabetic retinopathy

Resumo Objetivo: Avaliar o nível de conhecimento dos pacientes diabéticos, atendidos no Sistema Único de Saúde (SUS) na cidade de Boa Vista/Roraima, acerca da Retinopatia Diabética (RD). Métodos: Trata-se de um estudo transversal, descritivo, de caráter quantitativo, realizado através da aplicação de um questionário semi-estruturado para 150 indivíduos diabéticos, usuários do SUS, da cidade de Boa Vista - RR, durante o ano de 2017. As análises estatísticas foram realizadas utilizando os programas Microsoft Excel e EpiInfo 7®, fixando-se o nível de 5% para a rejeição da hipótese de nulidade. Resultados: Do total amostral pesquisado,76,7% dos indivíduos não possuía nenhum conhecimento sobre a RD, 19,3% tinha algum tipo de conhecimento, mas não possuía a patologia, 2,7% conhecia, possuía a RD e fazia tratamento e 1,3% conhecia, possuía a RD e não se tratava. Quanto a orientação, 40,6% dos participantes nunca recebeu nenhuma informação sobre o risco de perda da visão. Acerca do tipo de Diabetes, 44,7% dos participantes não sabia que tipo possuía, 42% relatou ter DM 2 e 13,3% DM1. Sobre o controle da glicose, 59,4% não conseguia mantê-lo. Foi evidenciada associação entre o controle da glicose e o conhecimento sobre RD, entre o tempo de instalação da DM e o conhecimento sobre RD e entre ter consultado um oftalmologista e conhecer sobre a RD. Conclusão: O nível de conhecimento sobre a RD é muito baixo, fator preocupante por tratar-se de uma das complicações mais importantes do Diabetes. Percebe-se que o sistema de saúde não está sendo eficiente como facilitador deste conhecimento.

Abstract Objective: To evaluate the level of knowledge of diabetic patients treated at the Unified Health System (SUS - Sistema Único de Saúde) in the city of Boa Vista / Roraima, about Diabetic Retinopathy (DR). Methods: This is a cross-sectional, descriptive, quantitative study conducted through the application of a semi-structured questionnaire for 150 diabetic individuals, SUS users, from the city of Boa Vista - RR, during the year 2017. Statistical analyzes were performed using the Microsoft Excel and EpiInfo 7® programs, setting the 5% level for the rejection of the null hypothesis. Results: Of the total sample, 76.7% of the individuals did not have any knowledge about DR, 19.3% had some type of knowledge, but did not have the pathology, 2.7% knew, had DR and was receiving treatment, 1,3% knew, had DR and was not receiving treatment. About orientation, 40.6% of the participants never received any information about the risk of vision loss. About the type of Diabetes, 44.7% of the participants did not know what type they had, 42% reported having DM 2 and 13.3% DM1. On glucose control, 59.4% could not maintain it. It was evidenced an association between glucose control and DR knowledge, between the time of DM installation and knowledge about DR, and between having consulted an ophthalmologist and knowing about DR. Conclusion: The level of knowledge about DR is very low, a worrying factor because it is one of the most important complications of diabetes. It is observed that the health system is not being efficient as facilitator of this knowledge.